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Updated: May 8, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The value of immediate postoperative MR imaging following endoscopic endonasal pituitary surgery
Douglas L Stofko1, Thomas Nickles, Haiyan Sun
1Department of Neurosurgery, Stroke and Cerebrovascular Center of New Jersey at Capital Health, Two Capital Way, Suite 456, Pennington, NJ, 08534, USA, douglas.stofko@gmail.com.
Background:
Although the value of early MR imaging has been justified for microscopic transphenoidal surgery, there is no literature evaluating immediate postoperative MR imaging following endoscopic endonasal resection of pituitary adenomas. We hypothesized that MRI of the pituitary gland performed on the first postoperative day is just as effective at detecting residual disease and/or reconstruction materials as the MRI at 3 months following surgery.
Methods:
We retrospectively evaluated 102 consecutive patients who underwent endoscopic endonasal surgery for presumed pituitary adenomas. Sixty-four patients met the inclusion criteria with immediate and 3 months MR imaging. Imaging was evaluated by two sets of observers. The following parameters were assessed: enhancement pattern of the pituitary gland, pituitary stalk, nodular enhancement (residual tumor) or linear enhancement (non-tumoral) and residual reconstruction/packing materials.
Results:
Gross total resection of the tumors with no cavernous sinus involvement was achieved in 49 out of 52 (94%) patients. Eleven out of 12 remaining patients with cavernous sinus invasion had residual cavernous sinus component visible on both immediate and 3 month MR imaging. The pituitary gland, position of stalk, and nasoseptal flap could be identified on both post-operative MRIs in all patients. The sensitivity and specificity for residual tumor detection on immediate MRI was 100% and 97.9%, respectively. The kappa index evaluating interobserver agreement for identification of residual tumor and packing/reconstruction material on immediate MR was 0.83 and 0.72 indicating near perfect and substantial agreement, respectively.
Conclusion:
Immediate MR imaging performed following endoscopic endonasal resection of pituitary lesions provides accurate and reliable information regarding the presence of residual tumor compared to reconstruction and packing materials.
Insights
Immediate postoperative MRI effectively detects residual pituitary adenoma after endoscopic surgery. This early imaging provides reliable results comparable to 3-month scans, aiding in surgical assessment.
Area of Science:
- Neurosurgery
- Radiology
- Endocrinology
Background:
- Early MR imaging is valuable for transsphenoidal surgery.
- No prior studies evaluated immediate postoperative MR imaging after endoscopic endonasal resection of pituitary adenomas.
Purpose of the Study:
- To evaluate the effectiveness of immediate postoperative MR imaging in detecting residual pituitary adenoma.
- To compare immediate postoperative MR imaging with 3-month postoperative MR imaging.
Main Methods:
- Retrospective evaluation of 102 patients undergoing endoscopic endonasal surgery for pituitary adenomas.
- Sixty-four patients with immediate and 3-month MR imaging were included.
- Two sets of observers assessed enhancement patterns, residual tumor, and reconstruction materials.
Main Results:
- High sensitivity (100%) and specificity (97.9%) for residual tumor detection on immediate MRI.
- Near-perfect interobserver agreement for residual tumor (kappa=0.83) and substantial agreement for materials (kappa=0.72).
- Pituitary gland, stalk, and flap identifiable on both immediate and 3-month scans.
Conclusions:
- Immediate postoperative MR imaging is accurate and reliable for detecting residual pituitary lesions.
- Early imaging provides comparable information to 3-month imaging.
- Useful for assessing residual disease and reconstruction materials post-surgery.
